지역사회거주 노인에서 한국어판 세계보건기구 장애평가조사표의 개반

윤진상,김재민,신일선,양수진,정태길,이형영 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.1

지역농산물을 활용한 가공사업의 의의와 과제 : 청주지역의 사례

윤병선, 하재찬, 이혜정 건국대학교 사회정책연구소 2012 사회과학연구 Vol.26 No.-

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지역사회거주 노인에서 한국어판 세계보건기구 장애평가조사표의 개발

윤진상,김재민,신일선,양수진,정태길,이형영 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.1

Objectives : This study aimed to develop the Korean version of World Health Organization Disability Assessment Schedule II (WHODAS II-K) with community dwelling elderly population. Methods : The WHODAS II-K was administered to 1204 community residents aged 65 or over in two areas of Kwangju, South Korea, in 2001. For assessing 'health condition', data on physical illness, depression (Korean version of Geriatric Mental State Schedule B3), and cognitive dysfunction (Korean version of Mini-Mental State Examination) were collected. For evaluating 'contextual factors', informations on demographic charactehstics (age, gender, living area, marital state, and religiou), socio-economic status (education, type of accommodation, number of room, previous occupation, and current employment), and social network were obtained. Results : WHODAS II-K showed high levels of internal consistency, split-half reliability, and inter-rater and test-retest reliabilities. In the correlation analyses, scores on the WHODAS II-K were significantly correlated with the unfavorable conditions in the all variables on health condition and contextual factors. Partial correlations of scores on the WHODAS II-K with health condition were significant even after controlling for contextual factors. Conclusion : The WHODAS II-K is a reliable and valid instrument for assessing disability in elderly population since it reflects physical illness, depression, and cognitive impairment, which are common in elderly.

쇄골 중간부 골절후 불유합 및 지연 유합의 원인

윤정로,심재익,김택선,이성종,김영배,김학준,안국환,장재영,홍명표 대한골절학회 2002 대한골절학회지 Vol.15 No.4

쇄골 중간 1/3 부위의 골절은 치료 결과가 양호하여 보존적 치료가 원칙적으로 받아 들어지고 잇으며 불유합에 대한 빈도도 낮은 것으로 되어 있다. 그러나 최근 전위 및 단축의 정도가 심할 경우 높은 불유합의 결과와 불량한 임상 결과를 보고하고 있어 이런 예에 대해선 수술적 치료를 권장하고 있다. 저자들은 단축 및 전위의 정도와 불유합의 연관성을 알아보고자 하였다. 연구 대상 및 방법 : 1993년 2월부터 2002년 1월까지 본원에 내원 했던 성인 중간부 쇄골 골절 환자 194명 중 완전 전위를 보인 78례를 조사하여 이중 63례를 대상으로 분석하여 후 향적 연구를 시행하였다. 4개월 추시 후에도 방사성 사진상 유합 소견이 관찰되지 않으면 불유합의 유의성을 알아보고자 하였다. 결 과 : 63례 중 불유합 및 지연 유합을 소견을 보인 환자는 15(23%)례였다. 골유합을 보인 48례의 단축은 평균 8.6㎜(2㎜-17㎜)였고, 전위는 평균 9.7㎜(2-22㎜)였다 .불유합 및 지연 유합을 보였던 15례에서 단축은 평균 14.5㎜(3㎜-37㎜), 전위는 평균 17.3㎜(4-25㎜)였다. 18㎜이상 단축이 있었던 경우 불유합의 발생과는 통계학적으로 유의성을 나타내었고(Fisher's exact test, p<0.01), Chi-square test상 16㎜ 이상의 전위를 보였던 경우 불유합 발생과 통계학적으로 의미가 있었다(p<0.01). 결 론 : 쇄골 골절 특히 중간 1/3의 골절은 비교적 보존적 치료에 결과가 좋은 것으로 되어 있으나, 전위 및 단축이 심한 경우 불유합에 대한 가능성이 높이 때문에 보다 경과 관찰시 유합의 진행이 없으면 적극적인 치료를 고려해야한다. Purpose : Because the prognosis of the mid 1.3 clavicle fracture is good, the conservative treatment with a figure of 8 bandage is the gold standard and the nonunions are rare. However, recently surgical treatment is recommended when the shortening and displacement is severe because of the high nonunion rate and the poor clinical result. This study was undertaken to evaluate that the shortening and displacement at fracture site are associated with the development of nonunion. Materials and Methods : We analysed the 194 fractures of mid 1/3 clavicle in adults which had been treated conservatively from February 1993 to January 2002 and did the retrospective study. Of these, 78 cases were originally in the middle third of the clavicle and had been completely displaced. We reviewed 63 of these cases. The shortening and displacement at the fracture site was measured on the initial roentgenogram. And the analysis of the patients' chart was done for another predisposing nonunion factors. Nonunion and delayed union are considered to be present when there has been little or no progression of clinical or radiographic healing at a minimum of 4 months after injury. Results : 15 of the 63 cases had developed nonunion.. The average 8.6㎜(2㎜-17㎜) shortening and average 9.7㎜(2-22㎜) in the union patients. The average 14.5㎜(3㎜-37㎜) shortening and average 17.3㎜(4-25㎜) in the nonunion patients. We found that initial shortening ≥18㎜(Fisher's exact test, p<0.01) and initial displacement ≥ 16㎜(Chi-square test. p<0.01)at the fracture site were significantly associated with the development of nonunion. Conclusion : The conservative treatment with figure-80-bandage is the gold standard in the clavicle middle one third fracture. However, the nonunion is commonly occurs in the cases of more of severely shortened and displaced fractures. If there are no signs of callus formation and the patient complains of pain after several week, osteosynthesis should be considered.

대두 식이섬유를 이용한 특수 영양식품의 유효성 평가

한재흠,이균희,손현수,이윤복,박점선,오만진 충남대학교 농업과학연구소 2008 농업과학연구 Vol.35 No.1

In the development of enteral foods for the patients with diarrhea, soybean hull, by-products of soybean processing, was used to prepare crude dietary fiber extracts (soybean hull fiber, SHF). Total dietary fiber content of SHF is 85% and their composition are 86.1% cellulose, 8.1% hemi-cellulose, and 4.7% lignin. The effects of SHF on the prevention of diarrhea were studied in animal. Spraque-Dawley (SD) rats were fed AIN93G diets containing 5% dietary fiber for 3days simultaneously inducing diarrhea with the phenolphthalein Mg citrate solution. On day 4, feces were collected at different time point. Dietary fibers used for the animal study were SHF, soybean cotyledon fiber (SCF), psyllium husk fiber (PHF), and chicory fiber (CF). α-cellulose was used as a control. Body weight gain, calorie consumed and food efficiency ratio among the experimental groups were not different. However, water content in the feces of SHF group was significantly lower by 10%, compared with other groups at 24hrs. time point. This effect was even greater in the feces collected later than 24 hrs. time point. SHF seems to have a greater effects on slow the symptom of diarrhea. Based on the previous results, enteral food enriched with SHF were prepared and its effect was compared with other commercially available products from domestic or imported ones. Weight changes among experimental groups were not different, but the moisture content of feces consumed SHF enriched products were lower than that of other products. Approximately 10% decrease in water content was observed from feces collected at 24 hr time point. According to the sensory evaluation, overall acceptability of the enteral food enriched with SHF was 3.24 out of 5 indicating that taste of this product is acceptable. 대두가공에 부산물로부터 얻어지는 대두 식이섬유를 이용하여 설사환자를 위한 경장 영양 식이를 개발하기 위하여 쥐에게 투여한 후 체중증가율, 변의 수분감소, 사료효율 등을 측정하여 다음과 같은 결과를 얻었다. 대두피 중의 식이섬유함량은 85% 이었고 cellulose 가장 높았으며 hemi-cellulose, lignin의 순 이었다. 대두 식이섬유가 대조구에 비하여 체중 감소율은 약간 낮았고 사료효율은 약간 높았다. 대두 식이섬유를 섭취시킨 쥐가 치커리 식이섬유, 차전자 피에 비하여 24시간 후의 변의 수분함량은 10% 낮았다. 대두 식이섬유를 첨가한 경장영양식이로 사육한 쥐의 체중변화와 사료효율은 3제품 간에 차이가 없었으나 다른 하나의제품은 대조군에 비하여 낮았다. 대두 식이섬유를 이용하여 가공한 경장영양식이 다른 상업용 제품에 비하여 실험쥐의 변 수분함량은 10% 이상 낮았다.

치매환자 부양자의 부양부단 결정인자

김재민,신일선,윤진상 大韓神經精神醫學會 2002 신경정신의학 Vol.40 No.6

연구목적 : 본 연구는 국내 치매환자 부양자의 부양부담 결정인자를 조사하고자 하였다. 방 법 : 79명의 치매환자 및 그 부양자에 대해, 부양부담척도와 부양부담에 영향을 미칠 수 있는 환자 및 부양자 관련인자를 조사하였다. 각 인자와 부양부담과의 관련성을 uni- 또른 bi-variate analyses로 검증한 다음, 부양부담의 결정인자를 알아보기 위해 stepwise muliple linear regression analyses를 시행하였다. 결 과 : '환자의 심한 우울증상' 과 '부양자의 낮은 자발적 부양동기'가 부양부담의 결정인자로 확인되었다. 결정인자는 아니었지만, 환자 관련인자 중 '짧은 유병기잔', 심한 행동 및 정신증상', 및 '심한 불안증상'이, 부양자 관련인자 중 '여성', '가사 담당', '짧은 자유시간,' 및 '나쁜 주관적 건강상태'가 부양부담과 관련을 보였다. 결 론 : 우리나라 치매환자 부양자의 부양부담을 줄이려면, 환자 측면에서 치매의 행동심리적 증상에 대한 치료적 개입이 중요하다. 부양자와 관련하여, 전통적 경로사상의 계승과 아울러 부양부담에 취약한 부양자에게 알맞은 다원적인 치료 서비스 및 시설이 요구된다. Objective : This study was done to explore the determinants of care burden of Korean caregiver in patients with dementia. Methods : For the seventy-nine patients with dementia and their caregivers, data on Caregiver Burden Inventory Korean version, and various patient- and caregiver related factors potentially related to care burden were investigated. Uni- or bi-variate analyses were performed to measure the relationship between individual factors and care burden, and then stepwise multiple linear regresssion tests were used to determine the independent risk factors. Results : Two determinants of care burden were identified : 'severer depressive symptoms in patients' and 'lower spontaneous care motivation in caregiver'. Of the patient related factors. 'shorter disease duration', 'severer behavioral and psychotic symptoms' and 'severer anxiety symptoms', and of the caregiver related factors, 'women', 'having household reponsibility'. 'shorter free time' and 'worse subjective health state' were related to care burden, although these were not identified as independent risk factors. Conclusion : To mitigate the care burden of Korean caregivers in patients with dementia, therapeutic interventions focused on the behavioral and psychological symptoms of patients would be essential in terms of patient related factors. With respect to caregiver related factors, in addition to the successsion of the philosophy of filial piety, establishment of multi-midal services and facilities suitable for the caregivers vulnerable to care burden would be needed.

노인에서 신체질환과 불면증 간의 전향적 연관성

김재민,김성완,양수진,김선영,배경열,조준영,윤탁,신일선,윤진상 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.5

Objectives : This study aimed to investigate the associations between physical disorders and prevalent/incident insomnia m a community dwelling older population. Methods : 1,204 people aged 65 or over evaluated at baseline. Insomnia was defined as difficulty in initiation or maintenance of sleep on at least three nights per week over the last month. Reported physical disorders covering 11 common and generally chronic health problems were ascertained. Covariates included were age, gender, education, housing, Past occupation, current employment, and depression. Of 879 without insomnia at baseline, 651 (74%) were followed 2 years later, and incident insomnia was evaluated. Results : Prevalent insomnia was significantly associated with 10 of 11 physical disorders. Incident insomnia was associated with 2 physical disorders : eyesight problems and hearing difficulty. Both prevalent and incident insomnia were significantly associated with increased number of physical disorders. Conclusion : Certain physical disorders were comorbid and precipitating factors of insomnia in elders.

광주광역시 치매의 유병률과 위험인자의 도시-농촌 지역 비교

신일선,김재민,윤진상,김석재,양수진,김웅장,이승현,강순아,곽지영,이형영 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.6

연구목적 : 본 연구의 목적은 광주광역시의 도시 및 농촌 지역에 거주하는 노인에서 치매의 유병률과 위험인자를 조사하고자 하였다. 부가적으로 이 두 지역간에 치매의 유병률과 위험인자를 비교하고자 하였다. 방 법 : 광주광역시의 전형적인 도시와 농촌지역의 65세 이상의 노인(N=1,598)을 대상으로, 2단계의 역학연구를 수행하였다. 1차 선별 단계에서는 38명의 훈련된 연구보조원이 대상노인을 면담하여, 사회인구학적 특징을 조사하고 한국판 간이정신상태검사(Korean version of Mini-Mental State Examination ; MMSE-K)로 평가하였다. 2차 임상 진단 단계에서는 1차 단계에서 MMSE-K 점수가 24점 이하인 노인(N=431)을 대상으로, 전문연구팀의 임상적 평가를 통해 치매를 진단하고 원인질환별로 알쯔하이머병(Alzheimer's disease ; AD), 혈관성 치매(vascular dementia ; VaD) 및 기타 치매로 분류하였다. 대상노인에서 치매의 유병률을 측정한 후, 광주광역시 전체 노인의 연령보정 유병률을 산출하였다. 전체 대상에서 AD의 위험인자를 조사한 후, 도시와 농촌군으로 나누어 분석을 다시 시행하였다. 결 과 : 1차 및 2차 단계의 참가율은 각각 71.0%(N=1,134) 및 83.2%(N=410) 였다. 연구 참여 노인(N=1,134)에서 전체 치매, AD 및 VaD의 유병률은 최소 각각 9.7%, 5.2%, 1.8%였다. 광주광역시 전체 노인의 연령 보정 유병률은 각각 10.7%, 5.7%, 1.9%인 것으로 산출되었다. AD의 독립 위험인자는 고령, 여성, 무학이었다. 도시와 농촌에 따른 유병률의 차이는 파악되지 않았다. 그러나 AD의 위험인자는 지역에 따라 차이가 있었다. 도시 노인에게는 무학만이, 농촌 노인에게는 고령과 여성인 경우가 독립 위험인자였다. 결 론 : 광주광역시 노인에서 치매의 유병률은 높았고, 이는 국내 다른 지역에서 수행된 선행연구 결과와 유사하였다. 알쯔하이머형 치매의 위험인자는 도시와 농촌에 따라 다른 결과를 보였다. 본 연구 결과는 한국에서의 치매의 실태를 반영하며, 치매의 적절한 관리와 예방을 위해서는 지역성 특성이 고려되어야 함을 시사한다. Objectives : The purpose of this study was to investigate the prevalence rate and risk factors of dementia in an urban and a rural sample of older persons in the metropolitan Kwangju area, Republic of Korea. In addition, the prevalence rate and risk factors of dementia between the two samples were compared. Methods : A two-phase epidemiological study of residents aged 65 or over(N=1,598) was conducted in a highly developed, urban and a non-contiguous, poorly developed, rural area of metropolitan Kwangju. In the first(screening) phase, 38 trained research assistants collectively peformed in-home interviews for all participants. Detailed sociodemographic characteristics were gathered and the Korean version of Mini-Mental State Examination (MMSE-K) was administered. In the second (diagnosing) phase, diagnosis of dementia was established for those scoring 24 or less on the MMSE-K in the screening phase(N=431), and etiological types of dementia were classified to Alzheimer's disease(AD), vascular dementia(VaD) or miscellanous type by two teams of experts. Prevalence rate of dementia was determined in the participants, and age-standardized prevalence rate adjusted by age distribution in metropolitan Kwangju was estimated. For AD, the risk factors were investigated in all participants, and analyses were repeated for the urban and rural samples separately. Results : The participating rates in the first and second phases were 71.0%(N=1,134) and 83.2%(N=410), respectively. In the participants, the prevalence rates of dementia(all types), AD and VaD were 9.7%, 5.2% and 1.8%, respectively. The age-standardized prevalence rates were 10.7%, 5.7% and 1.9%, respectively. Aging, female gender and no education(complete lack of formal education) were identified as independent risk factors for AD. No difference between the urban and rural samples was observed in the prevalence rates of dementia(all types), AD and YaD. However, risk factors for AD differed between these areas. In the urban sample, no education was the only significant factor ; whereas, aging and female gender were identified as risk factors in the rural sample. Conclusion : A high prevalence rate of dementia was observed among old persons in metropolitan Kwangju, consistent with previous studies conducted in other Korean areas. The risk factor profi1es for AD differed between urban and rural settings. The results of this study reflect the current status of dementia in Korea and suggests that appropriate management and prevention strategies for dementia should be tailored toward the geographic settings.

외상에 의하여 함입된 상악 중절치의 교정적 견인

한윤범,이제호,최형준,손흥규,김성오,송제선,최병재 대한소아치과학회 2009 大韓小兒齒科學會誌 Vol.36 No.2

외상에 의한 치아의 함입은 치아가 치조골 방향으로 변위되어 있는 상태이다. 함입성 탈구는 다른 유형의 탈구성 손상에 비하여 드물게 발생하고, 낙상에 의한 경우가 많으며, 소녀보다는 소년에서 호발하는 것으로 보고되었다. 치아가 함입되었을 때, 치수괴사나 유착, 치근흡수, 근관폐쇄, 변연골 상실 등과 같은 합병증이 발생할 수 있으며, 치아 경조직과 치아 지지조직 등의 손상이 동반되는 경우가 흔하므로, 예후를 예측하고 정확한 진단 및 치료계획을 수립하는데 어려움이 있다. 함입된 치아의 치료는 자발적으로 재맹출하기를 기다리거나, 교정적 견인 또는 외과적으로 재위치 시키는 방법이 있다. 이 증례는 외상으로 인하여 상악 좌측 중절치가 함입되었다는 주소로 내원한 6세 7개월 된 여아에서, 함입된 치아의 자발적인 맹출을 기대하였으나 맹출이 되지 않아서, 교정적으로 견인하여 맹출시킨 경우로 양호한 결과를 얻었기에 이를 보고하는 바이다. Traumatic intrusion is a type of injury that involves axial displacement of a tooth toward the alveolar bone. Its occurance is relatively rare compared to other types of luxation in permanent dentition. It is more common in boys than in girls, and most common etiology of intrusion is fallen down. Various complication may occur following traumatic intrusion, such as pulp necrosis, root resorption, pulp obliteration and marginal bone loss. In addition, traumatic intrusion is commonly combined with hard or soft tissue injuries. Therefore, it is difficult to establish proper treatment plan. Choice of treatment for an intruded tooth by trauma include waiting for spontaneous re-eruption, orthodontic repositioning, and surgical repositioning. In this case, we repositioned the intruded central incisor using orthodontic traction, in a six-year old girl, which failed to re-erupt spontaneously.

간호사들에서 월경전불쾌기분장애와 삶의 질, 사회직업기능 및 장애 간의 연관성

김선영,김재민,김웅장,양수진,김성완,신일선,윤진상 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.1

Objectives : This study aimed to investigate the prospective associations of premenstrual dysphoric disorder (PMDD) with quality of life, socio-occupational function and disability. Methods : 170 nurses were recruited 6om two general hospitals. Interviews were made at baseline and at four follow-up points (two mid follicular phases and two late luteal phases ofthe two consecutive menstrual cycles). The baseline evaluation Consis-ted of sociodemographic characteristics and menstmal history. PMDD was diagnosed by DSM-IV criteria after observation of the two menstrual cycles. The follow-up evaluations were consisted ofthe World Health Organization Quality of Life-Brief form, the Social and Occupational Functioning Assessment Scale, and the World Health Organization Disability Assessment Scale-II. Results : PMDD was detected 15 (8.8%) of 170 participants. The PMDD group showed significantly worse quality of life and socio-occupational functioning than the none-PMDD group particularly at the late luteal phases. No significant differences were found in sociodemographic characteristics and menstrual history between those with and without PMDD. Conclusion : PMDD was prospectively associated with worse quality of life and socio-occupational functioning in this study group.